Nursing Handoffs: Do We Know What Constitutes Best Practice?

By Sylvia Foley, AJN senior editor

The patient in the next bed by mynameisharsha / Harsha K R, via Flickr

A systematic literature review on nursing handoffs, written by nurse researcher Lee Ann Riesenberg and colleagues and featured as a CE article this month, might just shock you. The researchers found that although there is “abundant evidence that poor communication and variable procedures result in inadequate handoffs,” surprisingly little is known about what makes nursing handoffs effective. Which is kind of incredible, given how crucial handoffs are to providing safe and effective patient care.

Of the 95 English-language articles that met the researchers’ inclusion criteria, just 20 reported on research on nursing handoffs, and only 3 were found to be of reasonably good quality (scoring above 10 on a 16-point scale). The researchers concluded that although “the Joint Commission is calling for structured handoffs . . . we found very little evidence to support the use of any specific structure, protocol, or method.”

Barriers and Strategies
But the researchers were able to identify, categorize, and list numerous barriers to and strategies for handoffs that were mentioned in the literature. Among barriers, those categorized as communication barriers were noted most often; among strategies, those categorized as standardization strategies were so noted. Each list affords an intriguing look into the wide variety of barriers to and strategies for handoffs, and should prompt useful discussion.

Still, without evidence, it’s impossible to know what course of action is best. Riesenberg and colleagues call for “rigorous outcomes studies” that “focus on systems factors, human performance, and the effectiveness of protocols and interventions.” To learn more and find ideas for future research, read the article in AJN‘s April issue.

Have you had a particularly good (or bad) handoffs experience? Please tell us about it in the comments!